Publish in this journal
Journal Information
Visits
Not available
Vol. 73. Issue 11.
Pages 919-926 (November 2020)
Special article
DOI: 10.1016/j.rec.2020.06.035
Full text access
Spanish Heart Transplant Registry. 31th Official Report of the Heart Failure Association of the Spanish Society of Cardiology
Registro Español de Trasplante Cardiaco. XXXI Informe Oficial de la Asociación de Insuficiencia Cardiaca de la Sociedad Española de Cardiología
Visits
...
Francisco González-Vilcheza,
Corresponding author
cargvf@gmail.com

Corresponding author: Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Cantabria, Spain.
, Luis Almenar-Bonetb, María G. Crespo-Leiroc,d, Manuel Gómez-Buenoe, José González-Costellof, Félix Pérez-Villag, Juan Delgado-Jiménezd,h, José María Arizón del Pradoi, José Manuel Sobrino-Márquezj, Iago Sousa Casasnovask, on behalf of the Spanish Heart Transplant Teams
a Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
b Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
c Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Universidade da Coruña (UDC), Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain
d Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
e Departamento de Cardiología, Hospital Universitario Clínica Puerta de Hierro, Majadahonda, Madrid, Spain
f Servei de Cardiologia, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
g Servei de Cardiologia, Hospital Clínic Universitari, Barcelona, Spain
h Servicio de Cardiología, Fundación Investigación Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
i Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
j Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
k Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
Collaborators in the Spanish Heart Transplant Registry, 1984-2019 , Javier Segovia-Cuberoaa, Francisco Hernández-Pérezaa, Soledad Martínez Penadesbb, Mónica Cebrián Pinarbb, Raquel López Vilellabb, Ignacio Sánchez-Lázarobb, Luis Martínez-Dolzbb, María J. Paniagua-Martíncc, Eduardo Barge-Caballerocc, Gonzalo Barge-Caballerocc, David Couto-Mallóncc, Amador López Granadosdd, Carmen Segura Saintgeronsdd, Víctor Menjíbar Parejadd, Francisco Carrasco Ávalosdd, Manuel Coboee, Miguel Llano-Cardenalee, José A. Vázquez de Pradaee, Francisco Nistal Herreraee, Zorba Blázquezff, María Jesús Valeroff, Carlos Ortizff, Eduardo Zataraínff, Adolfo Villaff, Paula Navasff, Manuel Martínez-Sellésff, M. Dolores García Cosíogg, Laura Morán Fernándezgg, Pedro Caravacagg, Vicens Brossa Loidihh, Eulàlia Roig Minguellhh, Sonia Mirabet Pérezhh, Laura López Lópezhh, Isabel Zegríhh, Diego Rangel Sousaii, Nicolas Manito Loritejj, Carles Díez Lopezjj, Josep Roca Eliasjj, Elena García Romerojj, Gregorio Rábago Juan-Aracilkk, María Ángeles Castelll, Marta Farreroll, José Luis Lambert Rodríguezmm, Beatriz Díaz Molinamm, María José Bernardo Rodríguezmm, Cristina Fidalgo Muñizmm, Manuela Camino Lópeznn, Juan Miguel Gil Jaurenann, Nuria Gil Villanuevann, Iris Garrido-Bravooo, Domingo A. Pascual Figaloo, Francisco J. Pastor Pérezoo, Teresa Blasco-Peirópp, Ana Portoles Ocampopp, Marisa Sanz Julvepp, Luis de la Fuente Galánqq, Javier Tobar Ruizqq, Amada Recio Plateroqq, Luis García-Guereta Silvarr, Álvaro González Rocafortrr, Carlos Labradero de Lerarr, Luz Polo Lópezrr, Ferrán Gran Ipiñass, Dimpna C. Albert Brotonsss, Raúl Abella Antónss, Antonio García Quintanatt, María del Val Groba Marcott
aa Clínica Universitaria Puerta de Hierro, Majadahonda, Madrid
bb Hospital Universitario y Politécnico La Fe, Valencia
cc Hospital Universitario de A Coruña, A Coruña
dd Hospital Universitario Reina Sofía, Córdoba
ee Hospital Universitario Marqués de Valdecilla, Santander, Cantabria
ff Hospital Gregorio Marañón (adultos), Madrid
gg Hospital Universitario 12 de Octubre, Madrid
hh Hospital de la Santa Creu i Sant Pau, Barcelona
ii Hospital Universitario Virgen del Rocío, Sevilla
jj Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona
kk Clínica Universitaria de Navarra, Pamplona, Navarra
ll Hospital Clínic Universitari, Barcelona
mm Hospital Universitario Central de Asturias, Oviedo, Asturias
nn Hospital Universitario Gregorio Marañón (infantil), Madrid
oo Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia
pp Hospital Universitario Miguel Servet, Zaragoza
qq Hospital Clínico Universitario, Valladolid
rr Hospital Universitario La Paz, Madrid
ss Hospital Universitario Vall d’Hebron, Barcelona
tt Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Gran Canaria
This item has received
...
Visits
(Daily data update)
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (8)
Show moreShow less
Tables (7)
Table 1. Hospitals participating in the Spanish Heart Transplant Registry from 1984-2019 (in order of first transplant performed)
Table 2. Procedure type in the Spanish Heart Transplant Registry (1984-2019)
Table 3. Recipient characteristics in the Spanish Heart Transplant Registry (2010-2019)
Table 4. Donor characteristics and procedure times in the Spanish Heart Transplant Registry (2010-2019)
Table 5. Induction immunosuppression in the Spanish Heart Transplant Registry (2010-2019)
Table 6. Univariable survival analysis by baseline recipient, donor, and procedure characteristics (2010-2019)
Show moreShow less
Abstract
Introduction and objectives

The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019.

Methods

We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018.

Results

In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P=.34). Survival in both these periods was better than that from 2010 to 2012 (P=.002 and P=.01, respectively).

Conclusions

Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant.

Keywords:
Cardiac transplant
Registry
Survival
Resumen
Introducción y objetivos

Se presentan las características clínicas y los resultados de los trasplantes cardiacos realizados en España con la actualización correspondiente a 2019.

Métodos

Se describen las características clínicas y los resultados de los trasplantes cardiacos realizados en 2019, así como las tendencias de estos en el periodo 2010-2018.

Resultados

En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a años previos, los cambios más llamativos son el descenso hasta el 38% de los trasplantes realizados en código urgente, y la consolidación en el cambio de asistencia circulatoria pretrasplante, con la práctica desaparición del balón de contrapulsación (0,7%), la estabilización del uso del oxigenador extracorpóreo de membrana (9,6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p=0,34), y ambas mejores que la del trienio 2010-2012 (p=0,002 y p=0,01 respectivamente).

Conclusiones

Se mantienen estables tanto la actividad del trasplante cardiaco en España como los resultados en supervivencia en los últimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoría con dispositivos de asistencia ventricular.

Palabras clave:
Trasplante cardiaco
Registro
Supervivencia
Full Text
INTRODUCTION

In 2019, the heart transplant field celebrated its 35th anniversary in Spain. The Spanish Heart Transplant Registry was formed at the end of 1989 and published its first activity report in Revista Española de Cardiología in 1991.1 Produced under the principles of accountability and transparency, these documents have annually reported the activity and outcomes of all heart transplants carried out in Spain since the first such procedure was performed in 1984. Over time, the Spanish Heart Transplant Registry has become an essential tool for reporting the latest aspects of clinical practice in our country, as well as a clinical research platform.2

The present report provides an update on the activity and outcomes of the Spanish Heart Transplant Registry until December 31, 2019, with a special focus on the last 10 years.

METHODSPatients and procedures

A summary has already been published of the main methods used in the Spanish Heart Transplant Registry.3 In 2019, an adult heart transplant program was started in Dr Negrin University Hospital of Gran Canaria, bringing the total number of active centers to 19. There have been no changes from previous years in the structure of the activity of the distinct hospitals (eg, pediatric transplant, multiorgan transplant)4,5 (table 1). From 1984 to 2019, 8794 transplants were performed (figure 1); the Spanish Heart Transplant Registry has complete follow-up information on 8782 of these transplants, which form the basis of the current analysis. The types of transplants performed in 2019 and in the entire series are summarized in table 2. This report provides the relevant data for 2019 and compares them with those of the last 10 years (2010-2019). The changes over time for the period under study were analyzed in 3-year periods (2010-2012, 2013-2015, and 2016-2018), except for the percentage of urgent transplants, the types of pretransplant circulatory support, and donor age, which were analyzed by year.

Table 1.

Hospitals participating in the Spanish Heart Transplant Registry from 1984-2019 (in order of first transplant performed)

1.  Hospital de la Santa Creu i Sant Pau, Barcelona 
2.  Clínica Universitaria de Navarra, Pamplona, Navarra 
3.  Clínica Puerta de Hierro, Majadahonda, Madrid (adult, cardiopulmonary) 
4.  Hospital Marqués de Valdecilla, Santander, Cantabria 
5.  Hospital Reina Sofía, Córdoba (adult and pediatric) 
6.  Hospital Universitario and Politécnico La Fe, Valencia (adult and pediatric, cardiopulmonary) 
7.  Hospital Gregorio Marañón, Madrid (adult and pediatric) 
8.  Fundación Jiménez Díaz, Madrid (1989-1994) 
9.  Hospital Virgen del Rocío, Sevilla 
10.  Hospital 12 de Octubre, Madrid 
11.  Hospital Universitario de A Coruña, A Coruña (adult and pediatric) 
12.  Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona 
13.  Hospital La Paz, Madrid (pediatric) 
14.  Hospital Central de Asturias, Oviedo, Asturias 
15.  Hospital Clínic, Barcelona 
16.  Hospital Virgen de la Arrixaca, El Palmar, Murcia 
17.  Hospital Miguel Servet, Zaragoza 
18.  Hospital Clínico, Valladolid 
19.  Hospital Vall d’Hebron, Barcelona (pediatric) 
20.  Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Gran Canaria 
Figure 1.

Annual number of transplants (1984-2019), total and by age group.

(0.21MB).
Table 2.

Procedure type in the Spanish Heart Transplant Registry (1984-2019)

Procedure  2019  1984-2019 
De novo heart transplant  289  8409 
Heart retransplant alone  198 
Combined heart retransplant  7* 
Combined de novo heart transplant  168 
Heart-lung  83 
Heart-kidney  73 
Heart-liver  12 
Total  300  8782 
*

All kidney transplants.

Statistical analysis

Continuous variables are expressed as mean ± standard deviation, whereas categorical variables are expressed as percentages. Differences among time periods were analyzed using a nonparametric test for time series data (Kendall τ) for categorical variables and ANOVA (analysis of variance) with polynomial fit for continuous variables. Survival curves were calculated using the Kaplan-Meier test and were compared using a log-rank test. P < .05 was considered statistically significant.

RESULTSRecipient characteristics

Recipient characteristics are summarized in table 3. A total of 300 transplants were performed in 2019. Compared with 2018, the decrease in the number of procedures was mainly due to fewer pediatric patients (younger than 16 years old). The mean recipient age was 49.5 ± 17.8 years, with no significant changes in the last 10 years. Overall, 72.3% were men, confirming the trend in the last decade for an increase, albeit nonsignificant, in transplants in women. The percentages of multiorgan transplants and retransplants were stable, at about 2% overall. In the last 10 years, the only significant trends were the improvement in renal function at transplant and the increase in pretransplant cardiac surgery (both P = .04). The latter variable was correlated with increased use of ventricular assist devices in 2019, with a tendency for a slight decrease in the use of extracorporeal membrane oxygenation (figure 2). There was a major decrease in urgent procedures in 2019 (38.0%) vs the tendency of previous years (46.8% in 2016-2018) (figure 3).

Table 3.

Recipient characteristics in the Spanish Heart Transplant Registry (2010-2019)

  2010-2012 (n=726)  2013-2015 (n=813)  2016-2018 (n=906)  P for trend  2019 (n=300) 
Age, y  50.3±16.3  48.8±17.1  49.1±17.7  .18  49.5±17.8 
<16 y  6.5  7.7  8.6  .11  8.0 
> 60 y  29.3  27.8  30.1  .66  33.0 
Male sex  76.3  74.4  72.4  .07  72.3 
BMI  25.0±4.7  24.5±4.5  24.7±4.9  .09  24.8±4.9 
Underlying heart disease        .35   
Nonischemic dilated  37.3  35.9  37.0    38.0 
Ischemic  35.8  36.7  32.6    31.7 
Other  26.9  27.4  30.5    30.3 
PVR, WU  2.2±1.3  2.2±1.3  2.2±1.3  .72  2.1±1.3 
Glomerular filtration rate, mL/min/1.73 m2  76.7±34.5  79.6±36.5  80.5±37.7  .04  79.1±38.4 
Bilirubin> 2 mg/dL  15.5  16.2  16.9  .48  12.8 
Insulin-dependent diabetes  17.9  22.1  21.1  .16  19.0 
Moderate-to-severe COPD  7.7  11.8  10.5  .10  10.2 
Previous infection  13.7  14.5  16.0  .18  12.5 
Previous cardiac surgery  29.1  34.6  34.2  .04  38.7 
Type of transplant        .75   
Single  96.0  96.3  96.7    96.3 
Heart retransplant  2.1  1.8  1.5    2.0 
Combined  2.1  1.6  2.1    2.0 
Heart-lung  1.2  0.9  1.0    1.0 
Heart-kidney  0.7  0.7  0.7   
Heart-liver  0.1  0.3    0.3 
Pretransplant mechanical ventilation  14.9  15.2  14.5  .79  18.1 
Urgent transplant  36.2  45.9  46.8  <.001  38.0 
Pretransplant circulatory support        <.001   
No support  69.7  62.1  58.3    60.8 
Balloon pump  14.7  13.5  4.1    0.7 
ECMO  6.4  11.2  10.5    9.6 
Ventricular assist device  9.3  10.5  27.1    29.0 

BMI, body mass index; COPD, chronic obstructive pulmonary disease; ECMO, extracorporeal membrane oxygenation; PVR, pulmonary vascular resistance.

Values are expressed as percentage or mean ± standard deviation.

Figure 2.

Type of pretransplant circulatory support by year (2010-2019). ECMO, extracorporeal membrane oxygenation; VAD, ventricular assist device.

(0.14MB).
Figure 3.

Percentage of urgent transplants performed annually for the full series (2010-2019).

(0.06MB).
Donor characteristics and ischemia time

Donor characteristics are summarized in table 4. Donor age was stable vs the previous 3-year period, although the tendency for an increase in the last 10 years was highly significant. In 2019, 55% of donors were older than 45 years of age (figure 4). There was a slight decrease in the number of donors who died of stroke, with a corresponding increase in those who died of other causes. There was another small but consistent increase in the number of donors with pretransplant cardiac arrest (18% in 2019), although there was also a decrease in donors with mild dysfunction on pretransplant echocardiography. The cold ischemia time fell again, a tendency seen in the last 10 years, with an average time in 2019 of a little more than 3hours In addition, almost 3 of every 4 transplants were performed with a bicaval technique, a trend that now appears established.

Table 4.

Donor characteristics and procedure times in the Spanish Heart Transplant Registry (2010-2019)

  2010-2012 (n=726)  2013-2015 (n=813)  2016-2018 (n=906)  P for trend  2019 (n=300) 
Age, y  39.2±14.0  42.4±14.6  43.4±15.5  <.001  43.1±16.0 
Age> 45 y  39.4  50.1  57.3  <.001  55.3 
Male sex  65.6  57.3  61.0  .11  61.2 
Female donor-male recipient  21.4  26.1  22.1  .94  22.1 
Weight, kg  73.8±17.0  73.3±18.8  74.2±19.3  .60  75.6±20.2 
Recipient:donor weight  0.94±0.19  0.93±0.20  0.94±0.21  .43  0.92±0.20 
Recipient:donor weight > 1.2  7.1  7.1  7.6  .66  4.7 
Recipient:donor weight <0.8  19.0  21.6  23.8  .02  25.7 
Cause of death        <.001   
Trauma  31.4  24.1  21.2    21.7 
Stroke  46.6  49.6  54.1    50.7 
Other  22.0  26.3  24.7    27.6 
Pretransplant cardiac arresta  9.8  17.2  17.4  <.001  18.0 
Pretransplant echocardiographyb        .15   
Not performed  3.0  1.3  1.8    0.9 
Normal  94.8  95.5  95.4    97.4 
Mild generalized dysfunction  2.3  3.2  2.8    1.7 
Ischemia time, min  210.9±61.8  202.6±67.4  197.3±73.0  <.001  195.0±72.7 
≤ 120  9.9  12.5  17.9  .001  18.3 
120-180  19.0  22.5  19.8    22.0 
180-240  41.8  38.3  34.7    34.0 
> 240  29.2  26.7  27.7    25.7 
Bicaval surgical technique  66.3  67.5  72.3  .008  73.6 

Values are expressed as percentage or mean ± standard deviation.

a

Of 2331 transplants.

b

Of 2254 transplants.

Figure 4.

Annual changes in donor age and percentages of donors older than 45 years (2010-2019). 95%CI, 95% confidence interval.

(0.11MB).
Immunosuppression

Induction immunosuppression strategies are summarized in table 5. In 2019, the tendencies seen in the last decade were confirmed, with the almost exclusive use of triple therapy comprising tacrolimus, mycophenolate, and steroids. Likewise, more than 80% of patients received antibody-based induction therapy, mainly basiliximab.

Table 5.

Induction immunosuppression in the Spanish Heart Transplant Registry (2010-2019)

  2010-2012 (n=726)  2013-2015 (n=813)  2016-2018 (n=906)  P for trend  2019 (n=300) 
Calcineurin inhibitors, %
Cyclosporin  30.3  12.0  5.3  <.001  5.0 
Tacrolimus  69.7  88.0  94.7  <.001  95.0 
Antiproliferative agents, %
Mycophenolate/mycophenolic acid  99.6  99.1  99.5  .95  100 
Azathioprine  0.4  0.9  0.5  .95 
mTOR inhibitors, %
Sirolimus  0.4  0.3  0.6  .60 
Everolimus  2.3  2.1  1.3  .15  1.2 
Steroids, %  95.9  97.1  97.0  .25  97.8 
Induction, %        .08   
Not used  13.9  13.8  17.1    19.2 
ALG/ATG  3.6  2.7  4.3    2.7 
Anti-CD25  82.1  83.1  77.4    77.8 
Other  0.4  0.4  1.2    0.3 

ALG, antilymphocyte globulin; anti-CD25, basiliximab or daclizumab; ATG, antithymocyte globulin.

Survival

Survival was significantly better from 2010 to 2019 than from 1984 to 2009 (figure 5). This improvement was evident in both early survival (first posttransplant year) and mid-term survival (until the fifth posttransplant year). The final 3-year period (2016-2018) showed a significant improvement in survival vs the 2010 to 2012 period, although survival was similar to that of the immediately preceding period (2013-2015) (figure 6).

Figure 5.

Comparison of survival curves between the periods 2010 to 2019 and 1984 to 2009.

(0.1MB).
Figure 6.

Comparison of survival curves from 2010 to 2018 by 3-year period.

(0.08MB).

Factors related to survival from 2010 to 2019 (table 6) were maintained at similar levels to those of previous reports.3 The most notable result was that recipient age was associated with survival, unlike donor age. Recipient age > 60 years exerted a highly significantly effect on survival vs age < 16 years (P = .004). As in previous analyses, combined transplant and urgent transplant, due to the effect of pretransplant extracorporeal membrane oxygenation, continued to be associated with worse survival vs heart transplant alone and elective transplant, respectively.

Table 6.

Univariable survival analysis by baseline recipient, donor, and procedure characteristics (2010-2019)

  Hazard ratio (95%CI)  P 
Recipient age
<16 y   
16-60 y  1.2 (0.9-1.6)  .21 
> 60 y  1.6 (1.1-2.2)  .004 
Type of transplant
Single   
Combined  1.6 (1.0-2.4)  .049 
Retransplant  1.4 (0.9-2.2)  .19 
Donor age
≤ 45 y   
> 45 y  1.0 (0.9-1.2)  .75 
Urgency code
Elective   
Urgent  1.2 (1.0-1.4)  .009 
Type of support
No support   
Balloon pump  1.0 (0.8-1.2)  .80 
ECMO  1.7 (1.4-2.1)  <.001 
Ventricular assist device  1.1 (0.9-1.4)  .19 

95%CI, 95% confidence interval; ECMO, extracorporeal membrane oxygenation.

Causes of death

Infection, primary graft failure, and graft vascular disease/cardiac arrest were the most frequent causes of death in the first 5 posttransplant years during the last decade (figure 7). As expected, death from primary graft failure was concentrated in the first posttransplant month, causing a third of deaths. The leading cause of death in the period between the first month and first posttransplant year was infection (40.8% of cases), but was graft vascular disease/cardiac arrest between the first and fifth years (28.9%). These proportions mirror those observed in previous reports, as do the high incidence of death due to acute rejection observed between the first and fifth posttransplant years (18.6%) and that due to cancer in the same period.

Figure 7.

Main causes of death by time since transplant in the 2010 to 2019 period. GVD/CA, graft vascular disease/cardiac arrest.

(0.15MB).

Mortality in the first year due to primary graft failure and acute rejection stabilized in 2019. In contrast, 2019 showed a reduction of almost one-half in patients who died of infection in this early period (figure 8).

Figure 8.

Changes over time in the main causes of death in the first posttransplant year from 2010 to 2018 by 3-year period.

(0.12MB).
DISCUSSION

The main findings of the present updated analysis of the Spanish Heart Transplant Registry are as follows: a) confirmation of the trends detected in the last decade regarding the main recipient, donor, surgical procedure, and outcome characteristics; b) the apparent stabilization of these trends in 2019 vs the 2016 to 2018 period; and c) the striking change in the rate of urgent transplant and, related to this, the differences in the use of the various circulatory support devices.

The trends in the last decade that have tended to stabilize in the most recent period include the higher proportion of women receiving transplants, the improved pretransplant renal function, the higher age of donors, the use of donors with a larger body size than recipients, the use of donors who have had a cardiac arrest, the greater use of the bicaval technique, and the shorter ischemia time. Nonetheless, the most striking novelty is related to the type of pretransplant circulatory support, with an increase in ventricular assist devices, a stabilization in the use of extracorporeal membrane oxygenation (the only such procedure available in some hospitals), and the almost complete disappearance of balloon pump therapy.6 Consequently, there was an increase in sternotomy history (standard for ventricular assist device implantation) and decrease in urgent transplants. These changes are related to modifications in the inclusion criteria for the urgent waiting list introduced halfway through 2017 by the Spanish National Transplant Organization after an analysis of data from the Spanish Heart Transplant Registry.7 In the new criteria, the need for balloon pump support is no longer considered a situation necessitating urgent transplant and the window has been limited for the inclusion of patients receiving extracorporeal membrane oxygenation.

As has been the norm in previous reports, survival continues to improve. Thus, in the last decade, the 5-year cumulative survival was 71.7%, similar to that reported by the registry of the International Society for Heart and Lung Transplantation.8 However, analysis of the survival curves of the most recent 3-year periods seems to show that outcomes have been stable since 2013. The differences in the first posttransplant year were stable among periods. Although the result was not significant, our findings indicate that the improvement since 2013 might be related to reduced death from primary graft failure and stabilization of that from infection.

CONCLUSIONS

Spanish heart transplant activity in 2019 showed a stabilization of trends observed in the previous decade in terms of recipient, donor, surgical procedure, and outcome characteristics. Survival has been stable since 2013.

CONFLICTS OF INTEREST

None declared.

Appendix A
Material adicional

Hospital  Collaborators 
Clínica Universitaria Puerta de Hierro, Majadahonda, Madrid  Javier Segovia-Cubero, Francisco Hernández-Pérez 
Hospital Universitario y Politécnico La Fe, Valencia  Soledad Martínez Penades, Mónica Cebrián Pinar, Raquel López Vilella, Ignacio Sánchez-Lázaro, Luis Martínez-Dolz 
Hospital Universitario de A Coruña, A Coruña  María J. Paniagua-Martín, Eduardo Barge-Caballero, Gonzalo Barge-Caballero, David Couto-Mallón 
Hospital Universitario Reina Sofía, Córdoba  Amador López Granados, Carmen Segura Saintgerons, Víctor Menjíbar Pareja, Francisco Carrasco Ávalos 
Hospital Universitario Marqués de Valdecilla, Santander, Cantabria  Manuel Cobo, Miguel Llano-Cardenal, José A. Vázquez de Prada, Francisco Nistal Herrera 
Hospital Gregorio Marañón (adults), Madrid  Zorba Blázquez, María Jesús Valero, Carlos Ortiz, Eduardo Zataraín, Adolfo Villa, Paula Navas, Manuel Martínez-Sellés 
Hospital Universitario 12 de Octubre, Madrid  M. Dolores García Cosío, Laura Morán Fernández, Pedro Caravaca 
Hospital de la Santa Creu i Sant Pau, Barcelona  Vicens Brossa Loidi, Eulàlia Roig Minguell, Sonia Mirabet Pérez, Laura López López, Isabel Zegrí 
Hospital Universitario Virgen del Rocío, Sevilla  Diego Rangel Sousa 
Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona  Nicolas Manito Lorite, Carles Díez Lopez, Josep Roca Elias, Elena García Romero 
Clínica Universitaria de Navarra, Pamplona, Navarra  Gregorio Rábago Juan-Aracil 
Hospital Clínic Universitari, Barcelona  María Ángeles Castel, Marta Farrero 
Hospital Universitario Central de Asturias, Oviedo, Asturias  José Luis Lambert Rodríguez, Beatriz Díaz Molina, María José Bernardo Rodríguez, Cristina Fidalgo Muñiz 
Hospital Universitario Gregorio Marañón (pediatric), Madrid  Manuela Camino López, Juan Miguel Gil Jaurena, Nuria Gil Villanueva 
Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia  Iris Garrido-Bravo, Domingo A. Pascual Figal, Francisco J. Pastor Pérez 
Hospital Universitario Miguel Servet, Zaragoza  Teresa Blasco-Peiró, Ana Portoles Ocampo, Marisa Sanz Julve 
Hospital Clínico Universitario, Valladolid  Luis de la Fuente Galán, Javier Tobar Ruiz, Amada Recio Platero 
Hospital Universitario La Paz, Madrid  Luis García-Guereta Silva, Álvaro González Rocafort, Carlos Labradero de Lera, Luz Polo López 
Hospital Universitario Vall d’Hebron, Barcelona  Ferrán Gran Ipiña, Dimpna C. Albert Brotons, Raúl Abella Antón 
Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Gran Canaria  Antonio García Quintana, María del Val Groba Marco 

References
[1]
J.A. Vázquez de Prada.
Registro Nacional de Trasplante Cardiaco. Primer informe oficial.
Rev Esp Cardiol., 44 (1991), pp. 293-296
[2]
J.A. Vázquez de Prada, J.M. Arizón, L. Almenar Bonet, F. González-Vílchez.
Registro Español de Trasplante Cardiaco. Una visión histórica.
Rev Esp Cardiol Supl., 15 (2015), pp. 27-30
[3]
F. González-Vílchez, M. Gómez-Bueno, L. Almenar-Bonet, Spanish Heart Transplant Registry, et al.
28th official report of the Spanish Society of Cardiology Working Group on Heart Failure (1984-2016).
Rev Esp Cardiol., 70 (2017), pp. 1098-1109
[4]
F. González-Vílchez, L. Almenar-Bonet, M.G. Crespo-Leiro, Spanish Heart Transplant Registry. 29th official report of the Spanish Society of Cardiology Working Group on Heart Failure, et al.
Rev Esp Cardiol., 71 (2018), pp. 952-960
[5]
F. González-Vílchez, L. Almenar-Bonet, M.G. Crespo-Leiro, Spanish Heart Transplant Registry. 30th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure (1984-2018), et al.
Rev Esp Cardiol., 72 (2019), pp. 954-962
[6]
E. Barge-Caballero, F. González-Vílchez, J.F. Delgado, et al.
Use of intra-aortic balloon pump as a bridge to heart transplant in Spain: results from the ASIS-TC Study.
Rev Esp Cardiol., 72 (2019), pp. 835-843
[7]
E. Barge-Caballero, L. Almenar-Bonet, F. González-Vílchez, et al.
Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry.
Eur J Heart Fail., 20 (2018), pp. 178-186
[8]
K.K. Khush, W.S. Cherikh, D.C. Chambers, et al.
The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report — 2019; focus theme: Donor and recipient size match.
J Heart Lung Transplant., 38 (2019), pp. 1056-1066

See Appendix for the list of collaborators.

Copyright © 2020. Sociedad Española de Cardiología
Idiomas
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.